DIEP flap breast reconstruction--new experience.

Area of Science:

• Microsurgery
• Plastic and Reconstructive Surgery
• Oncology

Background:

• Autologous tissue reconstruction, specifically the free TRAM flap, has been the standard for breast reconstruction post-ablation.
• This method, while effective, is associated with significant abdominal wall morbidity, including weakness and hernia formation.
• Perforator flaps, which spare muscle and fascia, emerged as a potential alternative to reduce donor site complications.

Purpose of the Study:

• To evaluate the efficacy and safety of the Deep Inferior Epigastric Perforator (DIEP) flap for breast reconstruction.
• To compare the outcomes and morbidity of DIEP flap reconstruction with the traditional free TRAM flap.
• To assess the suitability of the DIEP flap for various breast sizes, including large pendulous breasts.

Main Methods:

• Retrospective analysis of breast reconstructions performed using the DIEP flap starting in 2000.
• Surgical technique involved harvesting a skin flap supplied by 1-2 perforators, with optional sensory nerve co-aptation.
• Comparison of operative time and postoperative complications with historical data from free TRAM flap reconstructions.

Main Results:

• Nine DIEP flaps were used for breast reconstructions within a five-month period, including two bilateral cases.
• Seven flaps achieved primary healing (p.p.i.), while two experienced postoperative venostasis requiring revision.
• Operative time was slightly longer than free TRAM flaps, particularly when sensory nerves were sutured.

Conclusions:

• The DIEP flap is a reliable and safe microsurgical option for breast reconstruction, offering significantly lower donor site morbidity.
• This technique is suitable for reconstructing large or pendulous breasts, providing satisfactory aesthetic and functional outcomes.
• Careful selection of perforators is crucial for successful DIEP flap harvesting.